Pharmacokinetic Profile, Safety, and Tolerability of Topical Berdazimer Gel, 10.3% in Patients With Molluscum Contagiosum

October 2022 | Volume 21 | Issue 10 | 1104 | Copyright © October 2022


Published online September 26, 2022

doi:10.36849/JDD.6938

Martina Cartwright PhDa, Carolyn Enloe MPHa, Stephen Stripling MDb, Tomoko Maeda-Chubachi MD PhD MBAa

aMedical Affairs, Novan, Inc., Durham, NC
bPediatric Department, Coastal Pediatric Research, Charleston, SC

Abstract
Background: Berdazimer (SB206), gel 10.3% is a novel, topical, nitric oxide–releasing agent intended for molluscum contagiosum (MC) treatment.
Methods: A 12-week, open-label, multicenter trial evaluated the safety, tolerability, and pharmacokinetic (PK) parameters of berdazimer gel, 10.3% applied topically once daily for the treatment of MC. Patients were aged ≥6 months with >20 molluscum lesions. The primary endpoint was the PK profile of the hydrolyzed N-methylaminopropyl-trimethoxysilane (hMAP3) monomer and nitrate during a 2-week period of once-daily berdazimer gel, 10.3% application (PK period) under maximal use conditions. Safety and tolerability were evaluated throughout the 12-week study period.
Results: Half of the 34 enrolled patients (17) were female and most (97.1% [33/34]) were white. Patients were 2 to 12 years old (mean, 5.3 years) with a mean of 50 MC lesions at baseline (mean time since MC awareness, 12.4 months). No patients had quantifiable plasma hMAP3 concentrations on day 1. On day 15, 2 patients had quantifiable plasma hMAP3 concentrations; however, the maximum concentration (33.9 ng/mL) was >10-fold lower than the no observed adverse effect level (NOAEL) in an animal toxicology study. Mean nitrate concentration–time profiles were similar on days 1 and 15 and remained flat for all patients throughout the 2-week PK period. The highest plasma methemoglobin level observed was 3.2%. Application-site pain (13/34 [38.2%]) and application-site erythema (6/34 [17.6%]) were the most frequent treatment-emergent adverse events (TEAEs), and most TEAEs were mild or moderate.
Conclusions: Once-daily berdazimer gel, 10.3% was well-tolerated with minimal systemic absorption.

J Drugs Dermatol. 2022;21(10):1104-1110. doi:10.36849/JDD.6938

INTRODUCTION

Molluscum contagiosum (MC) is a highly contagious viral skin disease characterized by raised, umbilicated, pink-to-red lesions.1 It is estimated that 6 million Americans suffer from MC, mostly children.2 US Food and Drug Administration(FDA)–approved prescription medication treatments for MC remain elusive,3 and an estimated two-thirds of patients with molluscum go untreated.4 MC infections may, therefore, persist from months to years.1

Nitric oxide (NO) is a small gaseous molecule with multiple physiologic and molecular functions, possessing immunomodulatory and antimicrobial properties.5 In the body, NO has a very short half-life and is metabolized to nitrate.5 The short half-life of NO and known endogenous functions make it a desirable therapeutic candidate for various diseases. However, NO is an unstable gas, and efforts to harness and control its release as a potential topical treatment for dermatologic diseases has been challenging.6

The active ingredient in berdazimer gel, 10.3% is berdazimer sodium, a new chemical entity affixed to a diazeniumdiolate silicon backbone that holds stable NO molecules.7 When combined with a hydrogel (proton donor) on the skin, NO is released in a controlled manner at the site of application.6 In vitro, berdazimer acts as an anti-viral and may have immunomodulatory properties, thus having the potential to influence multiple cellular and molecular aspects of MC pathogenesis.6,7 The objective of this open-label, multicenter trial was to evaluate the safety, tolerability, and pharmacokinetic (PK) parameters of berdazimer (SB206) gel, 10.3% once daily for the topical treatment of MC under maximal use conditions.

MATERIALS AND METHODS

Study Design
This was a phase 1, 12-week, open-label, multicenter trial designed to evaluate the safety, tolerability, and PK parameters of berdazimer gel, 10.3% applied topically once daily for the